What are political affairs?
The political affairs division of the FMEQ ensures medical students of Quebec are well represented at a governmental level. The FMEQ delegates keep up with the latest political developments relevant to medical students, whether it concerns their medical education or future practice. With this aim in mind, affairs relating to Education and Health are highlighted, since medical training is at a confluence of said major spheres of public and governmental interest, on a provincial and federal level alike.
By ensuring it’s presence amongst different committees and the submission of documents before the parliamentary committees, the FMEQ contributes to maintaining quality medical training at the foreground of our elected representatives’ priorities.
Promoting family medicine
Medical Student Scholarships
The Medical Scholarships granted by the College of Family Physicians of Canada recognize outstanding students that have demonstrated a marked interest and commitment to family medicine and aim to pursue a career in the field. Students in their second-last year of undergraduate medical school (generally Year 3 Clerkship) at the time of application are eligible candidates for this grant.
The deadline for submitting an application is April 15th 2015. The value of each scholarship is 10 000$. One scholarship is awarded in each Faculty of Medicine in Canada generally during the month of July of the same year. To learn more and submit an application, visit: http://www.cfpc.ca/les_étudiants_en_médecine/
Each year, the FMEQ is pleased to reveal their new edition of the Residency Guide, an essential tool when it comes to making important career choices.
Don’t hesitate to share it with all your colleagues, but especially to check it out yourself!
Click here to access the residency guide 2013-2014 version (http://issuu.com/acrochette/docs/guide_des_r_sidences_2013-2014_version_pdf), here for the 2014-2015 version (http://issuu.com/fmeq/docs/guide_des_r__sidences_2014-2015_ver) and here the latest 2015-2016 edition (http://issuu.com/remul4/docs/guide-des-re__sidences_fmeq_15-16/1)
We hope you will find this guide helpful!
Loans and Bursaries
What is Aide Financière aux Etudes (AFE) and what can it offer you?
The Aide financière aux études (AFE) is an autonomous service entity of the Ministry of Education, Leisure and Sport of Quebec. Their mission is to favour access to education by offering a loans and bursaries educational support program adapted to the financial needs of the student population.
Banks also offer student loans, but at the cost of accumulating interests throughout your medical studies. Most of all, banks do not grant scholarships (free of interest).
Indeed, AFE is a very attractive option for students: this program offers loans for which there are no interest until you have completed your studies, at which time you will begin to reimburse the sum borrowed, but not a minute before. This goes without saying that scholarship money is, by definition, never to be reimbursed.
For example, the amount granted to a fourth year medical student who does not have an income or other scholarships is approximately 13 000$, 4000$ of which is loans, while the remaining 9000$ is interest-free scholarship money.
When are students eligible for financial aid? This is what you will find out in the following text.
How much are you entitled to?
The amounts are highly variable from one student to another since the AFE program calculates financial needs as well as financial contributions received from elsewhere.
Before diving into predictions, let’s examine how the math is done.
The program calculates financial needs of each student based on eligible expenses and expected contributions at their respective level of study.
Eligible expenses –Contributions = Financial Needs
The program calculates the eligible expenses based on living expenses (which will vary depending on matrimonial status, whether staying in the parent’s home or not, etc.), tuition fees, cost of school computer hardware, transportation, medical fees, etc. For example, the government considers that a student residing with their parents pays 345$ in living expenses per month compared to 758$ for a student living alone. A questionnaire must be completed during the application so these expenses can be determined.
Next, the government takes into consideration the student’s income and their parents’, as well as scholarships other benefits earned to calculate the expected contribution of the student and his family. Parents like students, must contribute up to a certain salary threshold.
Once eligible expenses and contributions have been calculated, the second is subtracted from the first to obtain an amount that the government considers to represent the financial needs of the student. As you can see, amounts granted from one student to another will vary greatly. However, one rule subsists: if your financial needs are superior to the loan cap, you will receive the exceeding amount in scholarship money. The loan cap is the maximum amount the government will ask a student to reimburse in the future.
The loan cap is established according to the specific program you are enrolled in (in your case, undergraduate medical studies) and the duration of your full-time studies during that year. In 2011-2012, undergraduate students were entitled to 350$ per month of studies.
Your financial needs that are not covered by this monthly amount will be bridged by scholarship money. Of course, there is also a limit to this financial aid. The maximum amount of scholarship money granted was 16 252$ if you were an undergraduate in 2011-2012. This sum can vary every year.
Once financial aid is calculated and granted by the AFE program, you will be informed of the distribution of payments and the proportion of loans and bursaries you will receive.
Unfortunately, this type of financial support is not available for everyone. As mentioned previously, the aid program takes into consideration parental and spousal contributions. Due to the Civil Code of Québec, the parents must financially contribute to the cost of studies of a child (Articles 507 to 609). Parents have the obligation to nourish, to support and to educate their children, even if they are older than 18 years old. So, depending on the revenue of your parents (or spouse), the aid program will decided what contribution will be required for your studies.
If your parents have an income of less than 44 000$, no contribution from them will be demanded. On the other hand, if their income is greater than 44 000$, a contribution from them will be demanded, depending on the income level (higher income levels must contribute more support).
So it is possible that if your parents have high incomes, the AFE will not grant any financial aid unless you are considered independent from your parents. This occurs since the amount of contributions of your parents is equivalent to your financial needs.
So when are we considered autonomous then?
You are automatically considered autonomous if you have children (with certain condition), you’re an orphan, pregnant, married, or if you satisfy certain criteria tied to your studies.
According to the rules of the AFE “a student who has pursued university studies in Québec for at least 3 years and has accumulated 90 credits in a single program of study is not obligated to receive a contribution from their parents or legal guardian.” This means that all the students with a Bachelor’s degree or who have completed three years in a Doctor of Medicine starting from the usual path in one of the four Québec medical faculties are considered autonomous.
So: smiles to all students in their fourth year of university!
When do we have to reimburse this financial aid?
During the six months that follow the end of your studies, during residency, you will benefit from a partial exemption. You will not have to reimburse the loans of the AFE. There seems to be something missing between six months to the end of residency.
But, from the start of the month following the end of your residency, interest on this debt is now your responsibility. You can start immediately to pay the interest or let the interest accumulate for six months before paying. You can also ask that the interest is capitalized, that is added to your student debt.
Also, please be aware that the capital and interest can be reimbursed over a period of 15 years, by a monthly payment predetermined by the government.
How much does interest increase your loans?
During your studies, the government ensures the payment of the interest on your loans. From the moment you begin to repay your debt and throughout the period of repayment, you benefit from fiscal relief. Effectively, the government of Québec and Canada give you a non-refundable tax credit for the interest you have paid on a loan for your studies.
At the end of the partial exemption period, you are responsible to repay the debt from your studies. You should also finalize a repayment agreement with your financial establishment, who will give you a variable or fixed interest rate.
How to apply for the AFE?
If you want to benefit from the loan and grants program during your studies, you must apply for financial assistance through the internet (www.afe.gouv.qc.ca), in the Student online access tab. Once your request has been processed and approved by the student financial assistance services and throughout your studies, you must fulfill certain formalities to ensure that you receive the help you need. Here are the steps to follow:
1. Fill out the form on the website. It is essential to have your own social insurance number (SIN) and permanent code.
2. Have your request approved by the financial services of your university. They will forward your request to the government.
3. Once your request is approved by the financial services of your university and has been forwarded to the government, you will be granted an amount of loans and grant. This amount will be posted on your student online access on the Internet (an email will also be forwarded to you)
4. The government will issue a guarantee certificate that will be sent to the financial services of your university. You must go and retrieve it.
5. Hand the certificate in before the deadline in one of the following financial institutions: Caisse Desjardins, Bank of Montreal, National Bank or Royal Bank of Canada. Monthly amounts will then be automatically deposited in your bank account.
5. Update your tax returns.
The calcul simulator is a tool that allows you to estimate the amount of financial aid you could be granted though the loans and grants program for a given year.
Financial aid services:
-Université de Sherbrooke : Local E1-117, Pavillon de la vie étudiante
-Université de Montréal : Pavillon J.-A.-DeSève, 2332, boul. Édouard-Montpetit
4e étage, local B-4439
-Université Laval : Pavillon Alphonse-Desjardins, 2325, rue de l’Université, local 2546
-Université McGill : Pavillon Brown (Student Services, 3600, rue McTavish, Bureau 3200)
Medical practitioner distribution planning in Quebec
Medical practitioner distribution planning in Quebec
Important changes on their way
The medical workforce’s planning and distribution is not the most popular topic of discussion among medical students in Quebec. However, it is an unavoidable cornerstone of our training and future practice. It will have a determining impact on our career, influencing our specialty choice, the region we work in and the type of practice we have. In Quebec, the government has near absolute power over medical practice: the Ministry of Health determines the number of admissions to medical school, the distribution of residency training positions, the plans régionaux d’effectifs médicaux (PREM), that establishes where doctors can work, as well as oversees the activités médicales particulières (AMP) that require family physicians to do certain compulsory activities.
A shift in numbers for Québec physicians:
In recent years, distribution has greatly changed in Quebec. For instance, we went from nearly 6,500 practicing specialists in 1990 to over 8,300 in 2011. During the same period from 1990 to 2011, the number of family physicians increased from nearly 6300 to more than 7700. There has thus been a steady increase in the number of physicians in Quebec, with the exception of a period in the late 90s when the PQ government at the time encouraged accelerated retirements of physicians. Over the years, there has also been an increasing proportion of women in medicine. In 2010, women represented 49% of active family physicians and 35% of specialists. The age of physicians has followed the province-wide trend of an overall aging workforce. All these factors and many others have transformed the reality of medical practice in Quebec and will continue to have a significant impact in the future.
A variable that has been particularly important in the evolution of the medical workforce’s distribution in Quebec is the number of admissions to medical programs. In 2013, the number of admissions, although stable compared to last year, was at a record level of 847 admissions in the regular stream (879 if we add the special quotas (i.e., army, first nations, etc. .)). Until now, medical faculties have dealt with the high number of students appropriately, although some concerns about the quality of clinical exposure remain. The Ministry of Health has recently committed itself to reducing the number of medical admissions in the coming years.
The FMEQ fears that with an increased number of admissions, students have decreased clinical exposure and face a more challenging search for employment. We have seen in recent years that although many in Quebec do not have access to a doctor, the graduates of several medical disciplines are struggling to find jobs. This difficulty often reflects a lack of available resources and the reduction of the number of positions available (lack of operating rooms, personnel, equipment, etc.) These cases, initially sporadic, have since become more and more frequent, and, combined with admissions increases, have raised many concerns on our part. The FMEQ fears that some students might not find employment in Quebec at the end of their residence, an outcome we deem unacceptable considering that it is the MSSS that controls admissions, resident positions and job positions. During the year 2011-2012, the FMEQ subsequently took a stance in favour of a cautious reduction in admissions to medicine.
The MSSS has adopted a new method of calculating the appropriate distribution of the medical workforce in the long term, reflecting several key variables. The model takes a number of important factors into account, such as the number of admissions, the distribution of positions offered in residence, the position filling rate, the original Faculties of the students, the rate of installation in Quebec, arrival of students / residents / foreign doctors, age, attrition and more. The mathematical model seems reliable enough at the moment and makes it’s projections by altering the variables over which the government has control.
Too many specialists, not enough family physicians
The first results are quite striking. If no steps are taken to shift the present current, over the next 20 years we would have far more specialists than needed and too few family physicians to meet the needs of the population. However, regarding family medicine, services would be more efficient than they currently are. We cannot afford to train doctors who do not respond to the needs of the population, as this may lead to unemployment or exile of Quebec doctors.
After more than 600 projections, the model adopted by the government proposes a reversal of the traditional family medicine vs. specialty ratio to obtain, respectively, 55% family physicians and 45% specialists, and that, in 2017.
Distribution of residency positions
Previously, 45% of positions offered were in Family Practice versus 55% in medical specialties. Currently, the government aims for the 55-45 ratio by modifications of 1% per year. We are, in 2016, at 53% in Family Practice and 47% in medical specialties. FMEQ supports this change, as the medical students have clearly demonstrated a growing interest in Family Medicine with record rates of applications in this field. We are also aware that it better meets the needs of Quebec.
The distribution of specialty positions is based on the individual needs of each specialty, but also on the programs themselves and several other factors. It is therefore a somewhat unpredictable and imperfect process that is far from an exact science. The overall trend is downward in several specialties, including surgical specialties.
Changing needs of the population
Quebec’s population will change in the coming years, and their health needs will too. Based on various projections that seem fairly reliable, the Ministry calculated the number of physicians that would be needed to maintain the current service offered as well as the number of doctors needed to meet the real needs of the population, which is not currently the case.
There should be 11 400 specialists and 10 660 family physicians in 2032 to maintain current services and 12 200 specialists and 11 840 family physicians to meet the needs of the population.
It is difficult to argue with such figures. However, it begs a big question: can the system absorb all these numbers? Before new positions are opened, will some graduates hit a wall? In this context, the FMEQ defends the need for a cautious approach to admissions. The last position of the federation is to decrease them, even if this contradicts the strict needs of the population. It is important to have a long-term vision, but we must not lose sight of the short or medium term, where future doctors may find themselves unemployed because the government does not put the necessary means to hire them all in place.
What this implies for students today:
Prospective career choices are unfortunately limited for students. Universities will be, and has been implementing the new ratio of 55% of family medicine positions and 45% specialities in the short term despite the difficulties it will cause. Students should be aware, from the moment of their admission to medicine, that specialty positions will be increasingly limited.
There is no denying it: we need to train more family doctors as well as keep admissions numbers similar to what they are now if we hope to meet the population’s needs . We must ensure that the MSSS is not focused solely on the population’s needs, as they present significative discrepancies with the reality of training availability in the medical system. Unemployment in graduate medical students should be avoided at all cost.
The position of the FMEQ
Your student federation, with the agreement of your local associations, has positioned itself in favour of a cautious decrease in medical admissions. Although the model shows, from a strictly population-needs perspective, that the number of admissions should remain stable, our reality, in which new doctors are struggling to find employment Quebec, as well as government’s inability to ensure that all admitted students will be able to remain in Quebec, forces us to maintain our stance. As mentioned previously, it is important to have a long-term vision without unwittingly funnelling doctors towards unemployment and subsequent exodus, which could prove itself to be detrimental to the people of Quebec in the coming years.
In terms of the ratio of family physicians to specialists, the FMEQ ruled in favour of the 50-50 ratio currently achieved. The numbers, however, led us to believe that we will have to adapt rapidly, ensuring that the quality of education is not compromised.
In any case, rest assured that your federation will continue to work tirelessly to ensure that decisions taken by the government will not go against the interests of Quebec’s medical students. We will also continue to inform you of developments regarding these issues.